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Office of Public and Intergovernmental Affairs

Remarks by Deputy Secretary Sloan Gibson

West Point Society of DC
Fort Myer Officers Club, Washington DC
September 23, 2015

Imagine trying to overhaul a large healthcare system, update business processes, and implement an organization-wide cultural shift. Now imagine having to do all that in the Federal Government.

We have 535 board members — Congress — and two thirds of our workforce is unionized. Hiring is arduous, and firing is harder. We have onerous budget and acquisition processes and operate in an entrenched bureaucracy. And whatever we do is subject to intense scrutiny by powerful, competing interests.

I can’t think of any organization in America facing greater leadership and management challenges than VA.

Today I’d like to do two things: First, tell you some things about VA you maybe didn’t know. Second, tell you what we’re doing to earn back the trust of Veterans and the American people. Along the way, you’ll see how West Point graduates are rising to meet these challenges.

Last summer, after taking over as Acting Secretary, I met Dr. Harvey Fineberg, who had just stepped down after 12 years as the president of the Institute of Medicine. I told him that because of the health care crisis, VA could accomplish more in two-to-three years than we could otherwise have done in two-to-three decades. Dr. Fineberg immediately corrected me. “No!” he said, “VA can accomplish things now it never could have accomplished!”

Harvey was right. VA has an extraordinary opportunity and we must seize it!

When my good friend and classmate Bob McDonald arrived, we set forth three priorities: Rebuild trust with Veterans and stakeholders; Improve service delivery and focus on Veteran outcomes; and set a course for long-term excellence and reform.

The right priorities — but monumental goals in an organization the size and scope of VA.

VA’s the second largest agency in the Federal government with 350,000 employees — a third of them Veterans — and a $169 billion budget. 11 million of the 22 million Veterans living today are enrolled for health care or use at least one VA benefit or service.

Among our nine lines of business . . .

  • Last year, we provided $58 billion in compensation benefits to four million Veterans and their survivors.
  • We supported 100,000 disabled Veterans with $1.1 billion in vocational rehabilitation and employment benefits.
  • Since 2009, we’ve paid $55 billion in Post 9/11 GI Bill education benefits to 1.5 million Veterans and family members.
  • In 2014 alone, we guaranteed 440,000 home loans with a balance of $100 billion, and for the nearly 2.2 million home loans on our books, we have the lowest foreclosure rate in the industry.
  • Not many realize VA is the Nation’s 11th largest insurance enterprise with $1.3 trillion in coverage for Veterans, Servicemembers, and families.
  • And we operate 131 National Cemeteries, maintain 3.4 million gravesites, and perform over 125,000 interments each year.

If VA were in the private sector, we’d be a Fortune 10 company — and I’m just getting to healthcare, our ninth line of business.

We’re the largest healthcare system in America, serving nine million Veterans. We have 23,000 doctors, and our 96,000 nurses make VA the largest employer of nurses in the country. Last year, we completed over 55 million appointments for 6.6 million patients.

We’re affiliated with 1,800 academic institutions. Clinicians from many of the most prestigious medical schools in the country deliver care, teach, and conduct research at VA. The Chief of Staff of our Boston VA Medical Center is one of the deans at Harvard Medical School. At the UC San Francisco medical school, the entire faculty is credentialed to practice in VA, and all our medical center physicians there are members of the University’s staff.

Much of the credit for these relationships goes to a member of the Class of ’15 — General Omar Bradley. In 1946, when Bradley became Administrator of the VA, there were 16 million troops being demobilized — many on waiting lists at VA hospitals.

General Bradley’s solution was to partner with medical schools — for immediate access to physicians and residents, to medical students, and to research programs and prosthetics development.

Today, we train 64,000 residents and medical students, 27,000 nursing students, and 29,000 students in other health fields, every year. 70% of all U.S. physicians have received at least some of their training at VA hospitals.

We spend $1.8 billion annually on research. VA researchers . . .

  • Pioneered electronic medical records and bar-code software to safely administer medicines;
  • Developed the implantable cardiac pacemaker;
  • Proved an aspirin a day reduces risk in heart patients;
  • Conducted the first successful liver transplants;
  • Created the nicotine patch;
  • And demonstrated that patients with total paralysis can use their minds to control robotic arms.

VA researchers have received three Nobel Prizes and six Lasker awards. Just last year, two VA researchers at the Bronx VA received the Samuel J. Heyman “Service to America” Medal for groundbreaking work on spinal cord injuries.

So by any measure, VA innovation has contributed significantly to American healthcare — indeed, healthcare around the world.

I could tell you more:

  • Since 2004 the American Customer Satisfaction Index has shown that Veterans receiving VA healthcare give us higher satisfaction ratings than patients receiving care in private hospitals.
  • I could tell you that J.D. Power scored VA’s Mail Order Pharmacy the highest in overall satisfaction — every year for the last five years.
  • I could tell you that just last year, 24 VA medical facilities were recognized as “top performers” by The Joint Commission.
  • I could tell you that VA care compares favorably and outperforms our private-sector counterparts in many patient outcomes.

You may have seen Tina Rosenberg’s January piece in The New York Times. Let me share a few lines:

  1. “Hospital-acquired infection is one of the country’s leading causes of death, killing 75,000 people per year — more than car accidents and breast cancer combined.”
  2. “Yet hospitals have only started to take prevention seriously in the last decade, most in the last five years.”
  3. “One hospital group, however, has done more than all others. It’s not the Mayo Clinic’s hospitals, nor the Cleveland Clinic’s, nor Kaiser Permanente, nor Sutter, nor Geisinger. These are all hospital chains known for their quality, but another big name leaves them in the dust: the V.A.”
  4. She goes on to say that “V.A.’s achievement is even more remarkable because its patients are older and sicker than patients in other hospitals” … and that “V.A. shows how much faster we could go” in reducing hospital-acquired infections.

I could tell you all that and more — but if we have Veterans waiting too long for care or benefits, that’s not acceptable. So, we still have a lot of work to do.

What are we doing to confront our challenges and rebuild trust?

Our immediate priority has been improving access to care.

We’ve done that.

  • We expanded capacity by focusing on staffing, space, productivity, and VA Community Care.
  • VHA staffing is up more than 14,000 net — over 1,100 more physicians and 4,100 more nurses.
  • We’ve activated over 1.7 million square feet last year, and we’re more productive — clinical output has increased 8 percent.
  • One-and-a-half million Veterans were authorized care in the community in the last year — a 36 percent increase.

The results:

  • 97% of appointments are completed within 30 days of when the Veteran needs or wants to be see. But we know 87% are within 7 days, and 22% are same-day appointments.
  • Average wait times? — 5 days for specialty care, 4 days for primary care, and 3 days for mental health.

A little over a year ago, we had 300,000 appointments that couldn’t be completed within 30 days of when the Veteran needed or wanted to be seen. Today, that number is up 50% — to nearly 500,000.

How could that be?

We completed 7 million more appointments in the past year — twice what should have been required — but even as we did so, more Veterans were coming to VA for more of their care.

Keep in mind: 78 percent of Veterans receiving care at VA have either Medicare, Medicaid, Tricare, or private insurance.

So, we have more work to do.

That’s the latest on the Veterans Health Administration. What about the Veterans Benefits Administration?

The backlog of disability claims pending more than 125 days peaked in 2013 at 611,000 — It’s under 85,000 today, down 85% and still shrinking. Average days pending for all claims is now just 103 days, and VBA’s claims inventory is the lowest since 2008.

Tell me of another major part of the federal government that has transformed more in the last three years than VBA.

Long term, we have begun a major cultural and organizational transformation. It’s called MyVA, and it focuses on five objectives:

  • First, improve Veterans’ experience — a seamless, integrated, responsive customer-service experience, every time.
  • Second, improve employees’ experience —eliminate barriers to excellent customer service.
  • Third, improve internal support services.
  • Fourth, grow a culture of continuous improvement to identify and correct problems faster and replicate solutions nationwide.
  • Fifth, enhance strategic partnerships.

Who’s leading this transformation?

  • Bob McDonald, ’75, has set the course, providing the vision and direction.
  • Herman Bulls, ’78, is one of the 14 experts from the private, non-profit, and government sector on the MyVA Advisory Committee that General Joe Robles from USAA chairs.
  • Bob Snyder, ’81, directs the MyVA Task Force to integrate MyVA across the Department.

Working with Bob are . . .

  • Mike Haith, ’75,
  • Matt Collier, ’79,
  • Tom Muir, ’82,
  • Jim Wartski, ’82,
  • And Walt Cooper, ’99.

And that’s just the team focused on MyVA key initiatives. West Point grads are leading throughout the Department, including —

  • Tom Leney, ’73 (OSDBU)
  • Steve Best, ’76 (NCA)
  • Mark Romaneski, ’76 (OGC)
  • Bob Harrison, ’78 (VALU)
  • Gene Skinner, ’82 (OSDBU)
  • Norb Doyle, ’82 (VHA)
  • Chet Char, ’84 (VBA)
  • Monica Belisle Petring, ’84 (OPP)
  • Tom Kulich, ’84 (NCA)
  • Meg Gordon, ’84 (VHA)
  • Jack Kammerer, ’84 (VBA)
  • Glenn Powers, ’86 (NCA)
  • Marty Holland, ’87 (OPP)
  • Fernando Huerta, ’87 (HRA)
  • Elisa Basnight, ’91 (CWV)
  • Steven Cram, ’93 (OPP)
  • Paul McGlyn, ’95 (VBA)
  • Nancy Hogan, ’95 (VBA)
  • Michael Cho, ’96 (OM)
  • Matt Sullivan, ’01 (NCA)
  • Matthew Kim, ’01 (VBA)
  • Bo Cappibianca, ’03 (VBA)

Until recently, Joe Riojas, ’76, was our Chief of Staff and Assistant Secretary for Operations, Security, and Preparedness.

That’s just a sample drawn only from those based in D.C. Dozens more are serving Veterans across the Nation.

In closing, let me tell you about one of them: A couple of years ago, while I still with the USO, I got to see the new USO space under construction in Tampa, Florida, and while there I asked for a tour of VA’s new Polytrauma Center.

A few minutes later, this crusty-looking guy in blue jeans and a cowboy hard hat showed up to take us through the construction site. It turned out that Mike Tixier was a West Point grad I remembered from cadet days.

Mike gave us a great tour. By the time we were actually on the amazing Polytrauma floor, it was clear that he cared deeply about the work he was doing. In fact, one of the folks with me said, "Mike, you seem to be very passionate about what you're doing here."

He paused, which made me look right at his face, and I realized there were tears in his eyes. And he said, "That's because I know who it's for."

The lessons we learned, the values we instilled as cadets, are still with us today.

It’s hard to imagine the many ways in which West Point graduates continue to serve. So many grads have approached Bob and me offering to help, which affirms what we all know: It’s always been, and continues to be, about Duty, Honor, and Country.

Thanks for listening.